| NPI | 1104285980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | T. WAYNE BLOODWORTH President 678-567-5917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 114757) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2016-02-22 |